Surgical treatment of orbital tumors at a single institution

Abstract

Objective: The authors reviewed the experience of 19 patients with orbital tumors and summarize the clinical features, surgical treatment and outcomes.

Methods: The authors searched the database for all patients who underwent surgery for the treatment of orbital tumors at a single institution between 1999 and 2007. Data from clinical notes, surgical reports, and radiological findings were obtained for the analysis.

Results: Orbital tumors constituted a heterogenous array of histopathology. The presenting symptoms were exophthalmos (52.6%), visual disturbance (26.3%) and pain (21.1%). The surgical approaches used were transcranial in 17 patients. Tumors located in the intraconal or perioptic space were surgically excised using a frontoorbital approach (8 cases), while pterional (3 cases), orbital (2 cases) and combined approaches (6 cases) were used for tumors in other sites. Total resection of tumors was achieved in 12 of 19 patients. In 4 patients with glioma and lymphoma only diagnostic biopsy was done. Three patients experienced visual deterioration postoperatively. Two patients had temporary diplopia, and one patient had temporary ptosis.

Conclusion: Surgical treatment could be the mainstay of therapy for the majority of symptomatic orbital tumors. Many orbital tumors can be treated safely via a transcranial approach. Frontoorbital approach allows the surgeon to reach both the intraorbital and intracranial structures. Knowledge of the microanatomy of the orbit and meticulous surgical skills are necessary to overcome the pitfalls of intraorbital surgery.

Keywords: Approach; Exophthalmos; Orbit; Surgery; Tumor.

Fig. 1

Preoperative magnetic resonance images revealing a round and well-enhanced mass after gadolinium injection, occupying the entire intraconal region. It displaces the optic nerve laterally and indents the globe. A : T2-weighted axial. B : T1-weighted axial image. C : T1-weighted and enhanced axial image. D : T1-weighted and enhanced coronal image.

Fig. 2

Preoperative computed tomography images (A) demonstring an orbital lesion destroying orbit wall and sphenoid bone. Preoperative magnetic resonance images showing a poorly demarcated and enhanced mass in the left ocular and paraocular space (B : T2-weighted axial, C : T1-weighted and enhanced axial image, D : T1-weighted and enhanced coronal image).